Faculty Collaboration Database

Incidence and outcomes of Clostridium difficile-associated disease in hematopoietic cell transplant recipients. Int J Hematol 2014 Jun;99(6):758-65

Date

04/10/2014

Pubmed ID

24715522

DOI

10.1007/s12185-014-1577-z

Scopus ID

2-s2.0-84905392499 (requires institutional sign-in at Scopus site)   31 Citations

Abstract

Hematopoietic stem cell transplant (HSCT) recipients are at a high risk of Clostridium difficile-associated disease (CDAD) given frequent hospitalizations, prolonged antibiotic usage and altered integrity of intestinal mucosa. The prevalence and trends of CDAD in HSCT patients have not been extensively studied. In this study, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify CDAD in HSCT patients using a nationwide inpatient sample in the United States from 2000 to 2009. The prevalence of CDAD and in-hospital mortality in HSCT were investigated and compared to those without any transplants. Multivariate analysis was performed to identify if BMT and graft versus host disease (GVHD) were independently associated with mortality in CDAD patients. Of the 344,507 HSCT discharges, 4.7 % had CDAD. This was about 5 times higher when compared to non-transplant discharges. During engraftment admission, rates of CDAD were higher in allogenic group (8.4 vs. 5.7 %, p < 0.001). In subsequent admissions, those with GVHD had higher rates of CDAD (5.7 vs. 3.2 %, p < 0.001). On adjusted analysis in patients with CDAD, during engraftment admission, allogenic group had significantly higher mortality when compared with non-transplants (OR 3.7). Notably, there was no significant difference in mortality between patients with and without CDAD during the engraftment period for the allogeneic group. In subsequent admissions, there was higher mortality in those with GVHD (OR 4.8). Though the prevalence of CDAD in non-transplant population doubled (from 0.44 % in 2000 to 0.99 % in 2008), it has remained stable in HSCT patients (from 4.8 % in 2000 to 5.6 % in 2008). HSCT and GVHD are independently associated with CDAD though its presence does not affect mortality.

Author List

Guddati AK, Kumar G, Ahmed S, Ali M, Kumar N, Hari P, Venu N

Author

Parameswaran Hari MD Adjunct Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Comorbidity
Cross Infection
Enterocolitis, Pseudomembranous
Female
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Hospitalization
Humans
Incidence
Male
Middle Aged
Patient Outcome Assessment
Risk Factors
Young Adult